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FOROFFICE USE 11 <br /> i <br /> _ �-Z--- -;dd APPLICATION Mk-, SANITATION PERMIT Permit No. _ <br /> ------------------ - <br /> -_-- <br /> -- :k. <br /> Date Issued <br /> ._ r <br /> ` �/�,��- --I- (Complete in Duplicate) <br /> ---------------------------- - <br /> _________________________________ ------ ---------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made Ito the San Joaquin Local Health District for a permit to construct and install the work herein described: <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION-,_ - �* �--------------- _.AWe <br /> � <br /> Owner's Name----- - • �I' --- --• _--------•---------------------------- --------...---•-_.. Phone.......•••••-•.--------------- .. <br /> Address..._ r-_ ....... <br /> Contractor's Name-- ------t-----------------------------------------........................ Ph n -- <br /> o � $$G__3 73� <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> ill <br /> Number of living units: . __ Number of bedrooms _3. Number of baths ALLot size __I6P_r_A_..I-- ., �-------------- <br /> --- <br /> r <br /> Water Supply: Public system ❑ Commuriity system ❑ Private W Depth to Water Table $Q_ ft. <br /> yk� <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe®' Hardpan ❑ <br /> Previous Application Madel.,(If yes,date____________________) No,® New Construction: Yes No ❑ FHA/VA: Yes ❑ No 91 <br /> TYPE OF INSTALLATION : ND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> l e r <br /> Septic Tank: Distance from nearest well__ __ 'Distance from foundation----1_Q.___.......Material_F-Mar-°c KI.T......LOOAJ F <br /> No. of.cIk.om artments________ --------- _ Size__J _-S_k_5-__ .......Liquid de th____-___4-_♦_ -----------Caaci <br /> tY---��- •- � <br /> Disposal Field: Distance from nearest well- ._Distance from'Efoundation____1Q______.____Djs�nce to nearest lot line.______..... <br /> Number'of lines_____-3----------------_---------Length of each line��)_1117Q` �'�-VIdth of trench______�.4_'-_______________ <br /> Type of filter material;_ 2 Q�1C,-Depth of filter matenal______ _____Total length------.(_ C <br /> ----_____________________ <br /> See;page Pit: Di�tanc�to nea-r�esrt wellt.Oa�_r_ Distance from foundatio�___�s �. ..Distance to nearest lot line__�________ <br /> _, <br /> Number ofpits._._.-: .......... mate rial_�_0jCkC------Size: Diameter----33-------------Depth.......s ----------------- <br /> Cesspool <br /> ------------------ <br /> Cesspool: Distanc from nearest well-----------------Distance from foundation--- .-._. ____.Lining material------------------------------------- <br /> ❑ Size : :Diameter--------------------------------------Dept h-----------•---•--------- Liquid Capacity gals. <br /> l Privy: Distance from nearest well---------------------------_---------------------Distance from nearest building_______-.___-__.-----. -----............ <br /> ❑ Dista' ;W nearest lot line_____________________________________ <br /> Remodelingand/or r palr,J�e (describe)-----------------------------------------------------•-•............................ ...-------------••-------•••--•---••. --------- --------•--•- <br /> r y, �...�,.:. <br /> .................................. J-_.#_ .. ---------••------------------------------------------------------------•-••-•----••----•------•-••--------------•------•---------------------------------- <br /> •--•---•---...•-----••---••-•--•---• ....-,I11---------------•---------------------------------------------- ------------------ --------.........•---------------------------- <br /> --------------------------------------I----_---------------------------------------------------.............................-------------------------- ---- ---------- ------------------------------------------------------ <br /> ared this application and that the work will be done in accordance with San Joaquin County <br /> ! hereby certify that I?have prep <br /> ordinances, State IAWVh,. a" rule nd regulations of the San Joaquin Local Health District. <br /> -__._._(Owner and/or Contractor) <br /> Si"reed = <br /> ---------------------------------------------------------- <br /> By:--------------------- II:------------•-•----••---•------------•------------------- ---- ­--­----------------------- ----------------- <br /> (Plot <br /> ---- -----------(Plot plan, showing size of,lot, loeation of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> � <br /> FOR DEPARTMENT USE ONLY <br /> pq <br /> APPLICATION ACCEPTED BY - --- ------------ --------- --------------------------------- DATE----3----=-----1----4------------- - <br /> ! REVIEWED BY------------ ------ ---------• -- DATE <br /> BUILDING PERMIT ISSUED...- =-_- =-= <br /> ------=---- ==" ` ---------------•--•--------_-- DATE---- -------------•-...................................... <br /> F W lij; <br /> Alterations and/or redo mendations:------ ---:-----------------------•.-- - ----------------------- -• - <br /> - - <br /> --- ----- ----------- --------- = <br /> FINAL-iNSPECTIOW-8 l' - ------------------- Date U 1. . <br /> SAN JOAQUIN LOCAL HEALTH OSTRICT. <br /> 130 South American Street 300 West'Oak Simi,7,i'•"""^ ',124 Sycamore Street' 205 West 9th Street <br /> +r _. <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> EB 9 REVISED B•89 YM 6.61 ATL11 <br />